SFD (0203-034)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License# Lic. Class / Exp. Dat"
V75709 i 1 OrS1103
Date . _ 5Signature of Contractor
OWNER -BUILDER DE
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). ,
( ) I, as owner of the property, am exclusively I contracting with licensed
contractors to construct -the, project (Sec. 7044, Business &Professionals
Code).
() I am exempt under Section B&P.C. for this reason
r
Date `1x%" C:' . Signature of Owner �__ : f .-A. .w•
WORKER'S COMPENSATION DECLARATION w
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
()C).-1 have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier AMFiTUtnr"X PROTEC" Policy No. Z,113933"
(This section need not be completed if the, -permit valuation is for $100.00 or less).
( ) I certify that in the performance of/the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California? and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply w6h,thoee provisions.
Date:ylApplicants 1,,-""_- . i-✓ r't"• '. - .-.
Warning: Failure to secupe;Workers' Compensation coverage is unlawful and
shall subject an employer tc criminal penalties, -and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have xead this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of. this City to enter upon
the above-mentioned property forrinspection purposes. t..
Signature (Owner/Agent)`- 6, Dated'/t: y� "
BUILDING PERMIT PERMIT#Mf.0144
DATE VALUATION J2S.Jrrro4.$0 LOT 141 � TRACT 28819-2
JOB SITE
ADDRESS 1 1�.1r
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
115940 'V'0N' XA14V%N' AVM 200
D1"b+1` 1017 (YF A1ZHORTON
1MZ'.1!. Ch 92606
M`MM 9211606
(949>442.6199 C.B10
USE OF PERMIT
S'a14C9'I.EMOM Y;LW X12T0
Nee • L" .R . PLAN bb. VXRMIT LO ..S NUT INULLIVE 41,Ut, .
WA111% P004 Si'.;t4. OR D11.IVEWAY APPROA014. 751; ftMUC ION TO
PL.F, V CBECK nF, IMP, MU131PLE- !S tii NCE iiia EAM9P1. AN `EYP
OSTOM C011111TRUCTM34 oavb OF
F'ORC HIPATIO 766.00 IF
S� LX:ACz Cp.R1~DRT MAP aN
XM�+�- `MTF.D 1040yr OF L017'A7 J. k'aR./i.i 10N
281,442SO
CONSTRUCTION )ME 101.OW418,00 2 $1,276,50
Pt A24 CHECK. PEE 101-000-439-318 $160.17
MVCHAWCAL FSE 101-000-421e000 $114,00
pIsCd..`t'ki :.aha. irgz 1.01-0100.421-= 21122.20_
PLUMBIt�NVI nE 101-C 00 -41ST -000 11 4s'l,5
ST3?O"aJG MOTION PEE • AFMD 101-000-241-000 $23A4
ORADWO FER 101-000-423-000 320100
TJZrtYZL0PX-R IMPACT Fk: s,pir'.80
AWA 114 PUB12C REAMS' - USIK 270FWO-445.000
:>R-W.-TIOTAL iC;O2v161,90MO AND CRErK
$4,20-7.37�7
t LP"sA
-PL/d�%��BaS�4Q
1Nl%t ilN
°]?O:1'A,1k°F�19t1�':i';1W.S Dom` Now
$4,20 7
FMAY � � 2�0�
WYOFLAQUINKA
FINANCEDEPT
RECEIPT (
DATE
BY 1
DATE FI ALE
INSPECAOO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
INSPECTOR
J BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
oZ
Return Air
Steel
Combustion Air
Roof Deck
40
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingS
2 _
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath.
Drywall - Int. Lath
Final
BLOCKWALL APPROVA S
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test .
Electric Final
Waste Lines
da
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1i
Encapsulation
Gas Piping _
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
`
WES'T'ERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT: LA CALA
LOT #:y 21
SITE ADDRESS:- 81 125'MUIRFIEL-D-VILLAGE -LA�QUINTA CA.
------------------ _
EXTERIOR WALLS: BATTS
MANUFACTURER: KNAUF THICKNESS: 6 3/4" R- VALUE: R-19
CEILINGS:
BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION C0 T CTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PRODUCTI N
DATE: NOVEMBER
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF -4R
PROJECT INFORMATION
s _
Pro)@et Title:
Le Cala
Project Address:
Le Quints
Builder Name:
Western Pacific Homes, Michelle Lopez
Voice 0:
949-442-6193 K 462
Builder Contact:
John Zieman
Vole& X :
760-5647555
Project ID * :
28838-1
Sample Group 0:
Phase 4b
Lot 1X:
2021
Plan f1►
8
Address:
81.125 Mukfield Village
HERS INFORMATION
HERS Racer:
Scott Johnson Jayme Carden
CertMcatlon 0: '
CCCSJ614037 CCNJC615157
HERS Firm:
Action Now
Voice :
949-631-2274
Address:
2575 Westminster Avenue, Costa Mesa, CA 92627
HERS Provider
CHEERS
Voice # :
818.407-1 S00
HERS Address:
9400 Topangs Canyon Blvd, Chatsworth, CA 91311
HERS RATER COMPLIANCE STATEMENT
( x'j T•24 Compliance Credit was Taken for Tight Duds
ouee web:
Tested rx jApproved as a part of sample, but was not tested
x The losteller hes `' provided a copy of CF -9R
Air Distribution System is Fully Ducted (sheetmetal, ductboord or flex duct)
Whore doth backed rubber adhesive duet tape is installed, mastic and drawbands are used In combination With
doth backed, rubber adhesive dud tape to seal teaks at the connectkms.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Dlagnostic Leaka a Testing Results (Maximum 6% Dud Leakage)
GFA: CFA Leak Maus Nested Leak 7—
System
0
Indloate the maximum a Dud Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.6 x Floor Area x (0.06) for Climate Zones 1 through 7 & 18
400 x (Cooling Capacity in Nominal Ton$) x (0,D6)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
u Pressurization Test Results (CFM (M 28 PA)
100 x Test Leakage ! Fan Flow ;; % leakage
Check Box for Pass or Fall (Pass = 66/b or Less) Pass a
System of
Indicate the ffiaximum a W8 Ie Duct Leakage and the calWlation used:
0.7 x Floor Area x (0.06) for Gsnate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacity In Nominal Tons) x (0.08)
21.7 x (Meeting Capacity In Thousands of Output BTU per hour) x (0.06)
Other
u Pressurization Teat Results (CFM (W 25 PA)
100 x Test Leakage / Fan Flow ='A Leakage
Check Soot for Paas or Feil (Pass = 6% or Less) P448 a,
Systemof lf:
Indicate the maximum a owa le Duct Leakage and the calculation used:
0.7 x Floor Area x (0.06) for Climate Zone 8 through 15
0.5 x Floor Area x (0.06) for Climate Zones 1 through 7 & 16
400 x (Cooling Capacity in Nominal Tons) z (0,06)
21.7 x (Heat ng Capacity in Thousands of Output BTU per hour) x (0;06)
Other
u Preasuritation Test Results (CFM Q 28 PA)
100 x Teat Leakage / Fan Flow a % Leakage
Check Box for Pass or Fail (Pass = 6% or Less) PaeaFill
Raters C9"ng Signature
Date
F200-1.02 (3-02) Action Now T-24CF4RTDmacro.xl t
JAN.06.2003 12:22 17602334081 MAYER ROOFING
Corporate Office:
P.O. Box 40290
Escondido, CA 92046
WESTERN PACIFIC HOUSING
.LA QUINTA
760-5647022 (FAX)
Roofing on "LEGENDS (ia) P.G.A. WEST" Ph 4B
Attn: JOHN,
#3980 P.001/OOi
. u
® ® Phone: (7¢0) 737-8888
It�CORRO Eb
FAX: (760) 737-0350.
I.iernsc # (u�35R I
1-6-03
Mayer Roofing; has supplied and installed " 15 " 01hagin eloadced of vents, on lot # 2021
at 81-125 Muiriield Villiage, Tile vents have been installed per manufacturers
specifications_
Note: Exact. vent locations are determined by builder
RESPECTFITLLV SUBMITTED
Cel' �'
r
SCOTT BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page 1 of I
558 T,1)rw•v Sceeet.. San i arnando, CA 91340 193 OrInge Street . R ivci;cide c.'A 9250:
(818) 939-6064 . FAX (818j 838-4493(909) 782-0691 FAX (909) 71i'_'-f1K(14
Certificate of Occupancy
G
OF Building y p & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 81-125 MUIRFIELD VILLAGE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0203-034
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SHRI, LLC Address: 16940 VON KARMAN AVE. STE 200
City, ST, ZIP: IRVINE, CA 92606
By: DANIEL P. CRAWFORD, JR.
Date: FEBRUARY 20, 2003
Building Official
POST IN A CONSPICUOUS PLACE